Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency: a center for international blood and marrow transplant research analysis

A Mahindra¹, P Hari², R Fraser^{2

3}, M Fei², J Huang², J Berdeja⁴, N Callander⁵, L Costa⁶, M A Diaz⁷, C Freytes⁸, R P Gale⁹, S Girnius¹⁰, L Holmberg¹¹, M Kharfan-Dabaja¹², S Kumar¹³, R Kyle¹³, H Lazarus¹⁴, C Lee¹⁵, A Maiolino¹⁶, J Moreb¹⁷, T Nishihori¹², A Pawarode¹⁸, A Saad⁶, B N Savani¹⁹, J Schriber^{20

21}, B William²², B M Wirk²³, A Krishnan²⁴, Y Nieto²⁵, A D'Souza²

Affiliations

¹ University of California San Francisco Medical Center, San Francisco, CA, USA.
² CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
³ Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
⁴ Sarah Cannon BMT Program, Nashville, TN, USA.
⁵ University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
⁶ Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
⁷ Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
⁸ Texas Transplant Institute, San Antonio, TX, USA.
⁹ Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK.
¹⁰ University of Cincinnati, Cincinnati, OH, USA.
¹¹ Fred Hutchinson Cancer Research Center, Nashville, TN, USA.
¹² Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
¹³ Mayo Clinic Rochester, Rochester, MN, USA.
¹⁴ Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
¹⁵ Royal Adelaide Hospital, Adelaide, SA, Australia.
¹⁶ Hospital Universitario Clementinio Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
¹⁷ Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA.
¹⁸ Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, MI, USA.
¹⁹ Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
²⁰ Cancer Transplant Institute, Virginia G. Piper Cancer Center, Scottsdale, AZ, USA.
²¹ Arizona Oncology, Scottsdale, AZ, USA.
²² Ohio State Medical Center, Columbus, OH, USA.
²³ Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA.
²⁴ City of Hope National medical Center, Duarte, CA, USA.
²⁵ Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.

PMID: 28920949
PMCID: PMC5859934
DOI: 10.1038/bmt.2017.198

Multicenter Study

Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency: a center for international blood and marrow transplant research analysis

A Mahindra et al. Bone Marrow Transplant. 2017 Dec.

. 2017 Dec;52(12):1616-1622.

doi: 10.1038/bmt.2017.198. Epub 2017 Sep 18.

Authors

Affiliations

¹ University of California San Francisco Medical Center, San Francisco, CA, USA.
² CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
³ Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
⁴ Sarah Cannon BMT Program, Nashville, TN, USA.
⁵ University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
⁶ Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
⁷ Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
⁸ Texas Transplant Institute, San Antonio, TX, USA.
⁹ Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK.
¹⁰ University of Cincinnati, Cincinnati, OH, USA.
¹¹ Fred Hutchinson Cancer Research Center, Nashville, TN, USA.
¹² Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
¹³ Mayo Clinic Rochester, Rochester, MN, USA.
¹⁴ Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
¹⁵ Royal Adelaide Hospital, Adelaide, SA, Australia.
¹⁶ Hospital Universitario Clementinio Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
¹⁷ Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA.
¹⁸ Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, MI, USA.
¹⁹ Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
²⁰ Cancer Transplant Institute, Virginia G. Piper Cancer Center, Scottsdale, AZ, USA.
²¹ Arizona Oncology, Scottsdale, AZ, USA.
²² Ohio State Medical Center, Columbus, OH, USA.
²³ Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA.
²⁴ City of Hope National medical Center, Duarte, CA, USA.
²⁵ Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.

PMID: 28920949
PMCID: PMC5859934
DOI: 10.1038/bmt.2017.198

Abstract

Autologous hematopoietic cell transplantation (AHCT) in multiple myeloma (MM) patients with renal insufficiency (RI) is controversial. Patients who underwent AHCT for MM between 2008 and 2013 were identified (N=1492) and grouped as normal/mild (⩾60 mL/min), N=1240, moderate (30-59), N=185 and severe RI (<30), N=67 based on Modification of Diet in Renal Disease. Multivariate analyses of non-relapse mortality (NRM), relapse, PFS and overall survival (OS) were performed. Of the 67 patients with severe RI, 35 were on dialysis prior to AHCT. Patients received melphalan 200 mg/m² (Mel 200) in 92% (normal/mild), 75% (moderate) and 33% (severe) RI; remainder received 140 mg/m² (Mel 140). Thirty four of 35 patients with severe RI achieved post-AHCT dialysis independence. The 5-year PFS for normal, moderate and severe RI was 35 (95% CI, 31-38)%, 40 (31-49)% and 27 (15-40)%, respectively, (P=0.42); 5-year OS for normal, moderate and severe RI was 68 (65-71)%, 68 (60-76)% and 60 (46-74)%, respectively, (P=0.69). With moderate RI, 5-year PFS for high-dose melphalan 140 mg/m² was 18 (6-35)% and for Mel 200 was 46 (36-57)% (P=0.009). With severe RI, 5-year PFS Mel 140 was 25 (11-41) % and for Mel 200 was 32 (11-58)% (P=0.37). We conclude that AHCT is safe and effective in patients with MM with RI.

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Conflict of interest statement

The authors have no conflicts of interests to report

Figures

**Figure 1**
Kaplan-Meier survival curve of PFS and OS of pts with Normal/mild, moderate and severe renal insufficiency

See this image and copyright information in PMC

References

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Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency: a center for international blood and marrow transplant research analysis

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Autologous hematopoietic cell transplantation for multiple myeloma patients with renal insufficiency: a center for international blood and marrow transplant research analysis

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Conflict of interest statement

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